Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLMT URETRL STNT NEW WO CTH BI

Facility

$13,218.42

Service Code	HCPCS 5069450
Hospital Charge Code	2011577
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETRL STNT NEW WO CTH LT

Facility

$13,218.42

Service Code	HCPCS 50694LT
Hospital Charge Code	2011592
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETRL STNT NEW WO CTH LT

Facility

$13,218.42

Service Code	HCPCS 50694LT
Hospital Charge Code	2011592
Hospital Revenue Code	361
Min. Negotiated Rate	$318.56
Max. Negotiated Rate	$6,609.21
Rate for Payer: Aetna Commercial	$5,023.00
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,370.70
Rate for Payer: Cigna Commercial	$6,609.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,965.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Community & State	$318.56
Rate for Payer: Wellpoint Medicaid Managed Care	$350.29

PLMT URETRL STNT NEW WO CTH RT

Facility

$13,218.42

Service Code	HCPCS 50694RT
Hospital Charge Code	2011585
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETRL STNT NEW WO CTH RT

Facility

$13,218.42

Service Code	HCPCS 50694RT
Hospital Charge Code	2011585
Hospital Revenue Code	361
Min. Negotiated Rate	$318.56
Max. Negotiated Rate	$6,609.21
Rate for Payer: Aetna Commercial	$5,023.00
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,370.70
Rate for Payer: Cigna Commercial	$6,609.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,965.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Community & State	$318.56
Rate for Payer: Wellpoint Medicaid Managed Care	$350.29

PLMT XTN PROSTH EVASC RPR

Facility

$13,570.00

Service Code	HCPCS 34709
Hospital Charge Code	2004959
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

PLMT XTN PROSTH EVASC RPR

Facility

$13,570.00

Service Code	HCPCS 34709
Hospital Charge Code	2004959
Hospital Revenue Code	361
Min. Negotiated Rate	$327.04
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,071.00
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$327.04
Rate for Payer: Wellpoint Medicaid Managed Care	$359.61

PLMT XTN PROSTH EVASC RPR

Facility

$13,570.00

Service Code	HCPCS 34709
Hospital Charge Code	321034709
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

PLMT XTN PROSTH EVASC RPR

Facility

$13,570.00

Service Code	HCPCS 34709
Hospital Charge Code	321034709
Hospital Revenue Code	361
Min. Negotiated Rate	$327.04
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,071.00
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$327.04
Rate for Payer: Wellpoint Medicaid Managed Care	$359.61

PLP29371

Facility

$8,475.00

Hospital Charge Code	270657271
Hospital Revenue Code	278
Min. Negotiated Rate	$1,271.25
Max. Negotiated Rate	$2,050.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,864.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25

PLP29371

Facility

$8,475.00

Hospital Charge Code	270657271
Hospital Revenue Code	278
Min. Negotiated Rate	$204.25
Max. Negotiated Rate	$4,237.50
Rate for Payer: Aetna Commercial	$3,220.50
Rate for Payer: Aetna Medicare Advantage	$2,542.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,161.12
Rate for Payer: Cigna Commercial	$4,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,864.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25
Rate for Payer: UnitedHealthcare Community & State	$204.25
Rate for Payer: Wellpoint Medicaid Managed Care	$224.59

PLS AIM GUIDES .9MM X 10 DEG

Facility

$260.00

Hospital Charge Code	270671010
Hospital Revenue Code	272
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$52.00
Rate for Payer: UnitedHealthcare Community & State	$6.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.89

PLS AIM GUIDES .9MM X 10 DEG

Facility

$260.00

Hospital Charge Code	270671010
Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

PLSTC OP URTHRL SPHINCTER,VAGL

Facility

$42,389.30

Service Code	HCPCS 57220
Hospital Charge Code	1600000862
Hospital Revenue Code	360
Min. Negotiated Rate	$6,358.40
Max. Negotiated Rate	$6,358.40
Rate for Payer: Qualcare PPO/HMO/WC	$6,358.40

PLSTC OP URTHRL SPHINCTER,VAGL

Facility

$42,389.30

Service Code	HCPCS 57220
Hospital Charge Code	1600000862
Hospital Revenue Code	360
Min. Negotiated Rate	$1,021.58
Max. Negotiated Rate	$21,452.59
Rate for Payer: Aetna Commercial	$16,165.07
Rate for Payer: Aetna Medicare Advantage	$19,255.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,452.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,452.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5,943.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,452.59
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: Cigna Medicare Advantage	$5,943.04
Rate for Payer: Clover Medicare Advantage	$5,645.89
Rate for Payer: EmblemHealth Commercial	$17,829.12
Rate for Payer: Humana Medicare Advantage	$6,121.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5,943.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,716.79
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,358.40
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$1,021.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$5,943.04
Rate for Payer: Wellcare Medicare Advantage	$5,943.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1,123.32

PLT 12HOLE 4.0mmx144MmL427042S

Facility

$2,719.50

Hospital Charge Code	270638778
Hospital Revenue Code	278
Min. Negotiated Rate	$65.54
Max. Negotiated Rate	$1,359.75
Rate for Payer: Aetna Commercial	$1,033.41
Rate for Payer: Aetna Medicare Advantage	$815.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$693.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$693.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$543.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$693.47
Rate for Payer: Cigna Commercial	$1,359.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$658.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$598.29
Rate for Payer: Qualcare PPO/HMO/WC	$407.93
Rate for Payer: UnitedHealthcare Community & State	$65.54
Rate for Payer: Wellpoint Medicaid Managed Care	$72.07

PLT 12HOLE 4.0mmx144MmL427042S

Facility

$2,719.50

Hospital Charge Code	270638778
Hospital Revenue Code	278
Min. Negotiated Rate	$407.93
Max. Negotiated Rate	$658.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$543.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$658.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$598.29
Rate for Payer: Qualcare PPO/HMO/WC	$407.93

PLT AB HEPARIN IND

Facility

$309.00

Service Code	HCPCS 86022
Hospital Charge Code	38478102
Hospital Revenue Code	309
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$154.50
Rate for Payer: Aetna Commercial	$49.97
Rate for Payer: Aetna Medicare Advantage	$59.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.31
Rate for Payer: Cigna Commercial	$154.50
Rate for Payer: Cigna Medicare Advantage	$18.37
Rate for Payer: Clover Medicare Advantage	$17.45
Rate for Payer: EmblemHealth Commercial	$55.11
Rate for Payer: Humana Medicare Advantage	$18.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.37
Rate for Payer: Wellcare Medicare Advantage	$18.37
Rate for Payer: Wellpoint Medicaid Managed Care	$8.19

PLT AB HEPARIN IND

Facility

$309.00

Service Code	HCPCS 86022
Hospital Charge Code	38478102
Hospital Revenue Code	309
Min. Negotiated Rate	$46.35
Max. Negotiated Rate	$46.35
Rate for Payer: Qualcare PPO/HMO/WC	$46.35

PLT AGGREGATION

Facility

$152.15

Service Code	HCPCS 85576
Hospital Charge Code	38478101
Hospital Revenue Code	305
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$67.76
Rate for Payer: Aetna Medicare Advantage	$80.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.92
Rate for Payer: Cigna Commercial	$76.08
Rate for Payer: Cigna Medicare Advantage	$24.91
Rate for Payer: Clover Medicare Advantage	$23.66
Rate for Payer: EmblemHealth Commercial	$74.73
Rate for Payer: Humana Medicare Advantage	$25.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.82
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.91
Rate for Payer: Wellcare Medicare Advantage	$24.91
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

PLT AGGREGATION

Facility

$152.15

Service Code	HCPCS 85576
Hospital Charge Code	38478101
Hospital Revenue Code	305
Min. Negotiated Rate	$22.82
Max. Negotiated Rate	$22.82
Rate for Payer: Qualcare PPO/HMO/WC	$22.82

PLT ANT CERV ATLANTIS 27.5 MM

Facility

$10,510.00

Service Code	HCPCS C1713
Hospital Charge Code	270691793
Hospital Revenue Code	278
Min. Negotiated Rate	$1,576.50
Max. Negotiated Rate	$2,543.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,543.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,312.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,576.50

PLT ANT CERV ATLANTIS 27.5 MM

Facility

$10,510.00

Service Code	HCPCS C1713
Hospital Charge Code	270691793
Hospital Revenue Code	278
Min. Negotiated Rate	$253.29
Max. Negotiated Rate	$5,255.00
Rate for Payer: Aetna Commercial	$3,993.80
Rate for Payer: Aetna Medicare Advantage	$3,153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,680.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,680.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,680.05
Rate for Payer: Cigna Commercial	$5,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,543.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,312.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,576.50
Rate for Payer: UnitedHealthcare Community & State	$253.29
Rate for Payer: Wellpoint Medicaid Managed Care	$278.51

PLT BROAD SELF COMP 5-7 HOLE

Facility

$337.00

Hospital Charge Code	1602572
Hospital Revenue Code	274
Min. Negotiated Rate	$8.12
Max. Negotiated Rate	$168.50
Rate for Payer: Aetna Commercial	$128.06
Rate for Payer: Aetna Medicare Advantage	$101.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.94
Rate for Payer: Cigna Commercial	$168.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$74.14
Rate for Payer: Qualcare PPO/HMO/WC	$50.55
Rate for Payer: UnitedHealthcare Community & State	$8.12
Rate for Payer: Wellpoint Medicaid Managed Care	$8.93

PLT BROAD SELF COMP 5-7 HOLE

Facility

$337.00

Hospital Charge Code	1602572
Hospital Revenue Code	274
Min. Negotiated Rate	$50.55
Max. Negotiated Rate	$81.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$74.14
Rate for Payer: Qualcare PPO/HMO/WC	$50.55

Know your out-of-pocket cost for care.

All Charges